Sepsis and Jaundice

Abstract

To the Editor.— Maisels and Kring1 have suggested that indirect hyperbilirubinemia as the only manifestation of bacteremia or sepsis in the newborn period is a rare event. Indeed, a previous study by Benaron and Bowen2 has shown that neonatal sepsis is associated with decreased maximal indirect bilirubin levels in newborns. The authors of that study suggested that bilirubin is consumed as an antioxidant in response to the release of oxidants by phagocytic cells. However, our own data suggest that the decrease may be at least in part due to more rapid maturation of the hepatic conjugating and excretory mechanisms for bilirubin secondary to the acute phase response (or "stress").3